HomeMy WebLinkAbout913 BENSON LN - APPLICATIONS - 7/19/2017COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE
Job Site Address �&3 & e1nJ 41i1 Unit #,
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 970 q-SY (=>7 $ 2
Last nameFirst Name �iti ��l c Middle 1�
Street Address 9Z� _. 6�., 9c, A-,)d iJ City F64 (f 6,11, Kb State 6 Zip �O S—
CONTRACTOR INFO Company Name % V Tl"d— Contractor Phone # 3 0:3 9 IF FL32-.31?
Lic Holder Name
Mailing
City of Fort Collins License # Supervisor Cart #.
LEGAL INFO:
Subdivision/PUD �Cc 4 I �- �irC Filing # Lot #.
State Zip
Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 94 a 4-L Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
131 Floor Sq Ft
Finished Bsmt Sq Ft
20d Floor Sq Ft
# of Stories Bldg Height /D # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths /z Baths # of Fireplaces
Air Conditioning Yes No Energy info ( Circle appropriate choice ) 1 ComCheck 2 ResCheck w/Air Sealing
3 ResCheck w/Blower Door 4 Simulated Performance Alternative 5 Prescriptive w/Air Sealing 6 Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option
Water Tap Size Sewer Tap Size Metered Yes or No Temp Pedestal Yes or No
Type of Heat ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ % %: 7. GO
Description of Work 8 /Z T o+ T %a ^>4 0 -J
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Collins ordinances and state laws regulating building construction
Applicant Signature Gt� Print Name /i1 /, l /' Q 0"t- Phone C� 76 46-�7 07? -
Distribution White -Office Yellow -Applicant Pink - WWW/Stonnwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE